Gaetani Racquel S, Ladin Keren, Abelson Jonathan S
Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
Department of Community Health, Tufts University, Medford, MA 02155, USA.
Cancers (Basel). 2024 Aug 9;16(16):2807. doi: 10.3390/cancers16162807.
The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
几十年来，局部晚期直肠癌的管理发生了重大变革，最佳治疗方法也在不断发展。自1908年首次描述腹会阴联合切除术以来，手术、化疗和放疗取得了诸多进展，20世纪末和21世纪初化疗和放疗的时机得到确定，最近在2004年引入了器官保留或非手术治疗。伴随着这些进展，医学中共同决策的概念也在演变，促使人们关注以患者为中心的护理。这种实践中的演变源于对患者自主权重要性的日益认识以及治疗选择与患者价值观和偏好的契合。随着可能的治疗选择数量不断增加，患者咨询存在差异，这凸显了在局部晚期直肠癌中采用标准化共同决策方法的必要性。这篇叙述性综述将描述局部晚期直肠癌治疗选择的演变以及共同决策和决策辅助工具的概念，并将为已获得完全临床缓解且符合观察等待条件的局部晚期直肠癌患者引入一种决策辅助工具。
